KEEGAN ON LITHOLAPAXY.
June, 1886.]
?Higinal ^oiumitnicaiioit. LITHOLAPAXY IN MALE CEILDREN AND MALE ADULTS. V
A
By
r
OURTH SERIES OF UASES PERFORMED AT THE 1KDORE
Charitable Hospital. Surgeon-Major Caldecott and Surgeon-Major D. F. Keegan, M.D. (Dublin). In the June and {September numbers 01 this
I
aeries of the 7 th May, 1884, and the lltli August, 1885. These two series comprised 22 litholapaxies in boys and 32 litholapaxies in men, or a total of 54 All the litholapaxies in boys were cases. successful, and there was one fatal case amongst the 32 litholapaxies in men. I was absent from Indore on leave from the 12th August to the 10th November, 1885, during which time Surgeon-Major Caldecott performed my duties. During my absence 14 patients suffering from stone in the bladder were admitted into the Indore Hospital. On 13 of these cases SurgeonMajor Caldecott performed litholapaxy, and from one boy aged ten, whose urethra was very small, he extracted a phosphatic stone weighing 577 grains by lateral lithotomy. Surgeon-Major Cahlecott's cases were all successful. Since my return from leave to the preseut date, 27 patients, including 2 females, have been admitted into hospital suffering from stone. Oli 23 of these patients I have performed litholapaxy successfully, and on one boy, aged 1 year and 9 months, whose urethra would not permit the passing of a No. 6 catheter, I performed lateral lithotomy, and extracted a phosphatic stone weighing 107 grains. This case (lid well, and left the hospital in 13 days after the operation. We have therefore performed 93 litholapaxies in boys, .men and females from the 7th May, 1884, to the present date with 1 death. Appended is a table (A, p. 167) showing particulars of the fourth or last series of litholapaxies performed at the Indore Charitable Hospital. In this table there are several interesting cases of litholapaxy amongst boys, and amongst men there is only one case calling for any special mention, viz., Serial No. 149, where the stone weighed as many as2,80-1 grains. Serial No. 150 is also worthy of attention. I shall first of all briefly describe some of the most interesting cases amongst the series of
journal
for
1885,
published
two
lithobipaxies performed on boys and men at I u do re Charitable Hospital between the
litholapaxies
in
boys.
Serial No. 120.?Rama, a male Hindu, aged 9i years, was admitted into hospital on the 18th August, 1885, with stone in the bladder. Urine, alkaline, muddy colour; specific gravity, 1014; a trace of albumen. Next day, being the meatus of the placed under chloroform, urethra was slit up, when Nos. 9, 11, 13 and 14 evacuating catheters were passed with ease. Lithotrites Nos. 8, 10, 11, 14 and 15 were
Id
passed, and the stone proved too large for all these numbers except the last. The stone was eventually seized by No. 15 lithotrite and crushed. The operation lasted 3 hours and 2 minutes, and the water in the aspirator was clear to the end. 20th August,?There is great pain over the urethra and bladder when pressure is made ; considerable pain in passing urine ; colour of urine reddish brown. 21st?General condition unchanged; urine, light brown. 22nd ?Pain over bladder and urethra much less ; has fever. 23rd?Fever less. 24th?Penis is swollen. 26th?Much better; pain over bladder and paiu in passing water much less ; swelling of penis much diminished. 28th?Feels quite well now ; walks about the hospital verandah. 1st September?Gone home quite well. Remarks.?The stone in tiiis case weighed 700 grains, and consisted chiefly of uric acid with a nucleus of oxalate of lime and a thin covering of phosphates. Surgeon-Major CaldeIt is the largest that cott removed this stone. we have as yet removed from a boy's bladder by litholapaxy at the Indore Charitable Hospital. Had this boy been cut, lie would, in all probability, have remained in hospital for six weeks before being discharged, and had his urethra proved less capacious than it was, lateral lithotomy would, I think, have been the appropriate operation. Had his lines been cast in London in the present day, he would most probably have been subjected to Petersen's modification of suprapubic lithotomy. Serial No. 122.?Saligram, a male Hindu, aged 12, was admitted into hospital oil the 30th September with, symptoms of stone which had existed for one year. Specific gravity of urine, 1026 ; alkaline in reaction ; no albumen ; deposits of phosphates on standing. Being placed under chloroform, Nos. 11 and 14 lithotrites passed with ease. An oxalate of lime stone weighing 344 grains removed in 62 minutes. Respiration of patient during operation stopped suddenly ; patient revived under artificial respiration ; colour of water in aspirator quite clear during the operation. l.?? October.?No pain over urethra or bladder; urine quite clear and of amber colour ; feels no 2nd October?Feels pain in passing water. perfectly well; colour of urine normal; wishes 3rd October?Quite well; allowed to go home. to go home. Remarks.?Compare the history of this case subits history would sequent to litholapaxy to what have been had the stone been extracted by lateral lithotomy and the superiority ot litholapaxy over lateral lithotomy is at once established. Serial No.
128.?Allabelly,
2 years and 10
a
mouths,
Mahomedan
admitted into hospital with stone symptoms on the 11th On being placed under chloroform, November. a No. 7 catheter and a No. 7 lithotrite
boy, aged
was
passed
THE INDIAN MEDICAL GAZETTE.
162
with ease into the bladder. Weight of stone removed 16 grains; colour of water in aspirator clear throughout operation. \2tli Nov ember.?Has less pain in passing water Stream of urine than he had prior to operation. passes freely now ; colour ol urine, clear amber; cries a little when passing water. 18th November?No fever; urine, clear amber; cries less 14th November?Urine, when passing water. has clear; pain in passing water. slight quite 15th November?No pain ; gone home well. Remarks.?This boy was completely relieved of all symptoms of stone four days after operation. Had he been cut, he would very probably have not been discharged from hospital for 14 days. Serial No. 141.?Gopal, a male Hindu, aged 3 years and 3 months, was admitted into hospital on the 6th February, 1886. Being sounded, a stone was detected. Chloroform being administered, I tried to pass a No. 9 and then a No. 8 evacuating catheter, but I then passed found the meatus too small. without any difficulty a No. 7 evacuating catheter into the bladder, which I injected A partially-fenestrated No. 8 with tepid water. lithotrite passed with ease into the bladder. When in the bladder, I opened the blades of the lithotrite slightly to allow for clogging, and withdrew the lithotrite thus divaricated with the greatest ease through the membra
O)
03
2
a s
5.2 'a 2 '5?'p a a u 5 u
?
E.S
.5
? .s
w
3 2
ft
at the Indore Charitable
Hospital.
rz d)
E ?
6
167
Composition of Stonk.
-
a o o
=
O
O
?
a-J
3
-
? 115 116
Nun da* Nunda
117
Heeragir
60
3-9-85
118
Sookia*
5
119
Ghisia*
3
120
Rama*
121
Nathoo*
122 123
Saligram*
124
Yaseen
16-8-85 2-9-85
9i
7 15
7 16
33
15
16
9-9-85
62
7
7
15-9-85
18
8
7
19-9-85
182
29-9-85
36
30-9-85 8-10-85
...
Oonkar
50
&
11 & 15
10
13 & 14
11
62 21
14 & 11 15
12 & 13 29 French
31-10-85 37
15 & 11
Do.
I-11-85 4-11-85 8-11-85
30 24 48
125 126 127
Oonkar* Bheria*
Kisonsing*
...
128
Allabelly*
...
129 130 131
Shaik Amir...
Vakhutsing... Kutiayo*
132
Khema
60
24-11-85 33
15
June, 1886.]
?Higinal ^oiumitnicaiioit. LITHOLAPAXY IN MALE CEILDREN AND MALE ADULTS. V
A
By
r
OURTH SERIES OF UASES PERFORMED AT THE 1KDORE
Charitable Hospital. Surgeon-Major Caldecott and Surgeon-Major D. F. Keegan, M.D. (Dublin). In the June and {September numbers 01 this
I
aeries of the 7 th May, 1884, and the lltli August, 1885. These two series comprised 22 litholapaxies in boys and 32 litholapaxies in men, or a total of 54 All the litholapaxies in boys were cases. successful, and there was one fatal case amongst the 32 litholapaxies in men. I was absent from Indore on leave from the 12th August to the 10th November, 1885, during which time Surgeon-Major Caldecott performed my duties. During my absence 14 patients suffering from stone in the bladder were admitted into the Indore Hospital. On 13 of these cases SurgeonMajor Caldecott performed litholapaxy, and from one boy aged ten, whose urethra was very small, he extracted a phosphatic stone weighing 577 grains by lateral lithotomy. Surgeon-Major Cahlecott's cases were all successful. Since my return from leave to the preseut date, 27 patients, including 2 females, have been admitted into hospital suffering from stone. Oli 23 of these patients I have performed litholapaxy successfully, and on one boy, aged 1 year and 9 months, whose urethra would not permit the passing of a No. 6 catheter, I performed lateral lithotomy, and extracted a phosphatic stone weighing 107 grains. This case (lid well, and left the hospital in 13 days after the operation. We have therefore performed 93 litholapaxies in boys, .men and females from the 7th May, 1884, to the present date with 1 death. Appended is a table (A, p. 167) showing particulars of the fourth or last series of litholapaxies performed at the Indore Charitable Hospital. In this table there are several interesting cases of litholapaxy amongst boys, and amongst men there is only one case calling for any special mention, viz., Serial No. 149, where the stone weighed as many as2,80-1 grains. Serial No. 150 is also worthy of attention. I shall first of all briefly describe some of the most interesting cases amongst the series of
journal
for
1885,
published
two
lithobipaxies performed on boys and men at I u do re Charitable Hospital between the
litholapaxies
in
boys.
Serial No. 120.?Rama, a male Hindu, aged 9i years, was admitted into hospital on the 18th August, 1885, with stone in the bladder. Urine, alkaline, muddy colour; specific gravity, 1014; a trace of albumen. Next day, being the meatus of the placed under chloroform, urethra was slit up, when Nos. 9, 11, 13 and 14 evacuating catheters were passed with ease. Lithotrites Nos. 8, 10, 11, 14 and 15 were
Id
passed, and the stone proved too large for all these numbers except the last. The stone was eventually seized by No. 15 lithotrite and crushed. The operation lasted 3 hours and 2 minutes, and the water in the aspirator was clear to the end. 20th August,?There is great pain over the urethra and bladder when pressure is made ; considerable pain in passing urine ; colour of urine reddish brown. 21st?General condition unchanged; urine, light brown. 22nd ?Pain over bladder and urethra much less ; has fever. 23rd?Fever less. 24th?Penis is swollen. 26th?Much better; pain over bladder and paiu in passing water much less ; swelling of penis much diminished. 28th?Feels quite well now ; walks about the hospital verandah. 1st September?Gone home quite well. Remarks.?The stone in tiiis case weighed 700 grains, and consisted chiefly of uric acid with a nucleus of oxalate of lime and a thin covering of phosphates. Surgeon-Major CaldeIt is the largest that cott removed this stone. we have as yet removed from a boy's bladder by litholapaxy at the Indore Charitable Hospital. Had this boy been cut, lie would, in all probability, have remained in hospital for six weeks before being discharged, and had his urethra proved less capacious than it was, lateral lithotomy would, I think, have been the appropriate operation. Had his lines been cast in London in the present day, he would most probably have been subjected to Petersen's modification of suprapubic lithotomy. Serial No. 122.?Saligram, a male Hindu, aged 12, was admitted into hospital oil the 30th September with, symptoms of stone which had existed for one year. Specific gravity of urine, 1026 ; alkaline in reaction ; no albumen ; deposits of phosphates on standing. Being placed under chloroform, Nos. 11 and 14 lithotrites passed with ease. An oxalate of lime stone weighing 344 grains removed in 62 minutes. Respiration of patient during operation stopped suddenly ; patient revived under artificial respiration ; colour of water in aspirator quite clear during the operation. l.?? October.?No pain over urethra or bladder; urine quite clear and of amber colour ; feels no 2nd October?Feels pain in passing water. perfectly well; colour of urine normal; wishes 3rd October?Quite well; allowed to go home. to go home. Remarks.?Compare the history of this case subits history would sequent to litholapaxy to what have been had the stone been extracted by lateral lithotomy and the superiority ot litholapaxy over lateral lithotomy is at once established. Serial No.
128.?Allabelly,
2 years and 10
a
mouths,
Mahomedan
admitted into hospital with stone symptoms on the 11th On being placed under chloroform, November. a No. 7 catheter and a No. 7 lithotrite
boy, aged
was
passed
THE INDIAN MEDICAL GAZETTE.
162
with ease into the bladder. Weight of stone removed 16 grains; colour of water in aspirator clear throughout operation. \2tli Nov ember.?Has less pain in passing water Stream of urine than he had prior to operation. passes freely now ; colour ol urine, clear amber; cries a little when passing water. 18th November?No fever; urine, clear amber; cries less 14th November?Urine, when passing water. has clear; pain in passing water. slight quite 15th November?No pain ; gone home well. Remarks.?This boy was completely relieved of all symptoms of stone four days after operation. Had he been cut, he would very probably have not been discharged from hospital for 14 days. Serial No. 141.?Gopal, a male Hindu, aged 3 years and 3 months, was admitted into hospital on the 6th February, 1886. Being sounded, a stone was detected. Chloroform being administered, I tried to pass a No. 9 and then a No. 8 evacuating catheter, but I then passed found the meatus too small. without any difficulty a No. 7 evacuating catheter into the bladder, which I injected A partially-fenestrated No. 8 with tepid water. lithotrite passed with ease into the bladder. When in the bladder, I opened the blades of the lithotrite slightly to allow for clogging, and withdrew the lithotrite thus divaricated with the greatest ease through the membra
O)
03
2
a s
5.2 'a 2 '5?'p a a u 5 u
?
E.S
.5
? .s
w
3 2
ft
at the Indore Charitable
Hospital.
rz d)
E ?
6
167
Composition of Stonk.
-
a o o
=
O
O
?
a-J
3
-
? 115 116
Nun da* Nunda
117
Heeragir
60
3-9-85
118
Sookia*
5
119
Ghisia*
3
120
Rama*
121
Nathoo*
122 123
Saligram*
124
Yaseen
16-8-85 2-9-85
9i
7 15
7 16
33
15
16
9-9-85
62
7
7
15-9-85
18
8
7
19-9-85
182
29-9-85
36
30-9-85 8-10-85
...
Oonkar
50
&
11 & 15
10
13 & 14
11
62 21
14 & 11 15
12 & 13 29 French
31-10-85 37
15 & 11
Do.
I-11-85 4-11-85 8-11-85
30 24 48
125 126 127
Oonkar* Bheria*
Kisonsing*
...
128
Allabelly*
...
129 130 131
Shaik Amir...
Vakhutsing... Kutiayo*
132
Khema
60
24-11-85 33
15
